Make tummy time a fun time

Column by Brenda Pardy

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By Brenda J. Pardy, Pediatric Therapy Institute in Greenwood Village

Posted
2/9/12

Since 1994 pediatricians have been recommending that parents not
allow their young infants to sleep on their stomachs due to a
relationship between the incidence of Sudden Infant Death Syndrome
(SIDS) and sleeping in that prone position. According to the
American Academy of Pediatrics there has been a decrease in SIDS
deaths by 40 percent since that time, so keep up the good work in
having your baby sleep on her back!

As a result of all the time spent in back-lying or sitting
semi-reclined in car seats, swings, etc. we therapists have been
seeing an increase in children with flat spots on the back of their
skulls (plagiocephaly), weak neck muscles, and delayed gross and
fine motor skill development. Pediatricians are recommending that
at least 30 minutes per day be spent in tummy time. As an
occupational therapist working with children for over 30 years, I
would say that this is the bare minimum. The more time spent on the
floor, in a playpen the better. It needs to be supervised time so
that if the infant falls asleep, he can be turned to his back for
the nap. Rather than having your child laying on his back or seated
in a reclined infant carrier, use a front pack or body wrap carrier
whenever possible.

But, what if your child hates being on her tummy? When babies
used to spend a lot of time sleeping in that position, they found
it natural to be there. They spontaneously worked to lift their
heads up and pushed up onto their elbows then even higher onto
extended arms. Learning to push up against gravity helps to set
life-long muscle tone and is the beginning of developing strength
in the core muscles. Learning to bear weight through the shoulder
girdle is essential in learning to stabilize those joints.
Stability in the shoulders is necessary to learn to belly crawl and
creep on all fours. Refined finger dexterity develops more
effectively when the shoulders automatically hold themselves strong
in a neutral position when children begin to grasp and pinch. Now
babies often find it uncomfortable to lay on their stomachs since
they have to work so hard to hold their heads up and they are not
used to it.

Start early. Begin tummy time as soon as you bring your baby
home from the hospital for a minimum of 30 minutes total time per
day, broken up into small segments. Use a head support for your
newborn in a carseat or infant carrier to hold his neck straight.
Use carriers as little as possible. Once the baby has some head
control, (about four months) try sitting him in a bumbo/boppy seat.
It is a C-shaped pillow that supports a child as they are learning
to sit up, but puts no pressure on the head.

Get down on the floor face to face with your baby, cooing,
making faces, singing, showing her toys. Keep her company when she
is on her tummy. Older siblings and pets can help with the
entertainment.

Have her lie on your tummy while you are lying on your back to
see each other eye.

Lay him on a firm surface such as the bed while you sit on the
floor at eye level (Not shown). Be sure to hold him to keep him
safe, especially after he can roll. Give his shoulders some support
to keep him happy for longer periods of time until his arms are
stronger.

Use commercially available toys that include positioning
pillows, or roll up a hand towel to provide support under her chest
as she learns to push up onto her elbows, then all the way up onto
her hands.

Most parents tend to hold their baby in the same arm when laying
him down, and so his head is at the same end of the crib every
time. Switch directions with each bedtime so he will be facing the
other way. Hold your baby in the other arm whenever feasible. This
comes naturally with breastfeeding, but should be done with the
bottle as well.

When using an infant seat be sure to move it around the house so
that interesting things to look at are not always in the same
direction to encourage head turning. It takes extra effort to move
a head that has flattened on one side, so some infants avoid it and
the neck muscles become shortened on one side in a condition known
as torticollis. If the child's head is not symmetrical to start
with, that can affect neck control as well.

After some head control has developed (at about 4 months) hold
him lying on his tummy across your forearms sometimes so that he
can look around from that position instead of cradling him in your
arms. If you lie on your back and bring your knees to your chest,
the baby can lay on your lower legs to play face to face.

If you notice that your son or daughter has a consistent head
tilt, struggles to lift his or her head or that you are concerned
about the shape of your baby's skull, consult your pediatrician.
You might be referred to a pediatric physical or occupational
therapist, who can recommend stretches, exercises, activities and
positioning specific to your child's needs. If you have questions
about your child's motor, speech or behavioral development call us
at 303-649-9007.